Pediatric Pelvis Imaging Guidelines

This policy covers pediatric pelvis imaging (primarily ultrasound and advanced imaging such as MRI, CT, and fetal MRI) for a broad range of pediatric pelvic indications including female conditions (e.g., abnormal uterine bleeding, PID, endometriosis, adnexal mass, pelvic pain) and male conditions (e.g., undescended testis, scrotal pathology), and applies to patients <18 years (patients ≥18 follow adult pelvis guidelines). Major limitations/requirements: a recent (≤60 days) face-to-face evaluation is expected before advanced imaging, ultrasound is generally recommended prior to advanced studies, MRI with contrast is rarely used and anesthesia/contrast contraindications must be considered, atypical presentations require physician review, and screening asymptomatic patients or routine repeat imaging without evidence of progression is not supported.

"Abdomen/Pelvis CT without and with contrast | CPT 74178"